GuideLiner catheter facilitated PCI--a novel device with multiple applications.

OBJECTIVE: The GuideLiner catheter (Vascular Solutions, Inc.) is a monorail guiding catheter extension that serves to facilitate stent delivery and is approved for providing extra support and coaxial guide engagement. The objective of this manuscript is to familiarize interventionalists with this new device, describe its versatile uses, and its limitations with case-based examples. BACKGROUND: Failure of stent delivery is responsible for 5% of procedural failures in coronary interventions in the current era. Different techniques to enhance guiding catheter support and facilitate device delivery have been described. These include use of buddy wires, anchoring balloons at different locations for extra support for device delivery, and even rotational atherectomy in the most calcified lesions. METHODS: The database of coronary interventions at Banner Good Samaritan Medical Center was queried for use of the GuideLiner catheter and stents. The angiograms of all those cases were reviewed and selections of cases highlighting different uses of the catheter were chosen for inclusion in this manuscript. RESULTS: All potential uses of the GuideLiner catheter are described in this manuscript. Nuances about use and tips and tricks related to the device are also discussed in the case examples. CONCLUSIONS: The manuscript provides a complete summary of the different uses and limitations of the catheter and its contemporary role in modern day coronary intervention.

The prognostic importance of isolated P-Wave abnormalities.

BACKGROUND: While certain P-Wave morphologies have been associated with abnormal atrial size and either pulmonary or cardiovascular (CV) disease, their relationship to mortality and specific cause of death has not been reported. METHODS: Analyses were performed on the first digitally recorded electrocardiogram (ECG) on 43 903 patients at the Palo Alto Veterans Administration Medical Center since 1987. After appropriate exclusions, 40 020 patients remained. Using computerized algorithms, P-wave amplitude and duration in 12 leads as well as several standardized ECG interpretations were extracted. The main outcome measures were pulmonary and CV mortality. RESULTS: During a mean follow-up of 6 years there were 3417 CV and 1213 pulmonary deaths. After adjusting for age and heart rate in a Cox regression model, P-wave amplitude in the inferior leads was the strongest predictor of pulmonary death (hazard ratio [HR]: 3.0, 95% confidence interval [CI]: 2.3-3.9, P < .0001 for an amplitude > 2.5 mm), outperforming all other ECG criteria. The depth of P-wave inversion in leads V(1) or V(2) and P-wave duration were strong predictors of CV death (HR: 1.7, 95% CI: 1.5-2.0, P < 0.0001 for a P-wave inversion deeper than 1 mm), outperforming many previously established ECG predictors of CV death. CONCLUSIONS: P-wave amplitude in the inferior leads is the strongest independent predictor of pulmonary death while P-wave duration and the depth of P-wave inversion in leads V(1) or V(2) significantly predict CV death. These measurements can be obtained easily and should be considered as part of clinical risk stratification.

Takotsubo cardiomyopathy after coronary intervention developed during hospitalization.

Stress-induced cardiomyopathy is an increasingly recognized syndrome characterized by transient apical or midventricular dysfunction that mimics myocardial infarction in the absence of significant coronary artery disease. We describe a case of takotsubo syndrome that developed in an anxious patient within a few hours after a coronary interventional procedure. We believe that this will be the first case of takotsubo syndrome that developed in an inpatient after a coronary procedure, who was very concerned and anxious before the procedure.

Percutaneous treatment of severe carotid stenosis due to Takayasu's arteritis early after carotid endarterectomy.

Takayasu's arteritis is a chronic inflammatory disease primarily involving large vessels. The diffuse, multifocal and progressive nature of the vascular lesions make surgical repair difficult. We describe successful carotid stenting of a 39-year-old female who presented with symptomatic, aggressive, long-segment carotid restenosis 6 months following left carotid endarterectomy. Repeat angiography 6 months later revealed continued patency.

Impact of platelet glycoprotein IIb/IIIa Inhibition on the paclitaxel-eluting stent in patients with stable or unstable angina pectoris or provocable myocardial ischemia (a TAXUS IV substudy).

Whether the benefits that glycoprotein IIb/IIIa inhibitors confer in patients who undergo bare metal stent implantation extend to drug-eluting stents is unknown. We performed a prespecified subgroup analysis of the TAXUS IV study population to examine the effect of procedural glycoprotein IIb/IIIa inhibition during paclitaxel-eluting stent implantation on periprocedural creatine kinase-MB (CK-MB) levels. Glycoprotein (GP) IIb/IIIa inhibitors were administered to 57.7% of patients who had been randomized to receive the TAXUS stent and to 56.7% of those who had been randomized to receive the control stent. Among patients who received the TAXUS stent, the rate of CK-MB increases of >3 times the normal level was 2.6-fold higher in those who received a GP IIb/IIIa inhibitor than in those who did not (11.4% vs 4.4%, p = 0.0015). Composite rates of major adverse cardiac events and target vessel failure were also higher at 1 month in the GP IIb/IIIa group. By multivariate analysis, use of GP IIb/IIIa inhibitors during stenting with the TAXUS stent was an independent predictor of CK-MB increases >3 times the normal level. Further studies are warranted.

Subclavian artery pseudoaneurysm successful exclusion with a covered self-expanding stent.

Subclavian pseudoaneurysms are rare clinical entities occurring most commonly after iatrogenic injury to the subclavian artery. The management of subclavian pseudoaneurysms remains a challenge because of their non-compressibility and close proximity to vital intra-thoracic structures. Until recently, the treatment of choice was surgical intervention. In this case report, an iatrogenic subclavian pseudoaneurysm was successfully managed using a covered, self-expanding stent after an uncovered stent was unsuccessful in sealing the pseudoaneurysm.